Puerto Rican Elders' Knowledge and Use of Community-Based Long-Term Care Services

We conducted 3 focus groups with 28 Spanish-speaking Puerto Rican elders to explore their knowledge and use of community-based long-term care services, including an exploration of whether their residential setting influences access to services. Analysis revealed themes relating to participants' difficulties and frustrations with formal services. A major theme was a reliance on formal services, given a lack of reliable familial help. Elders living in Latino senior housing reported the greatest access to services, with availability of Spanish-speaking housing staff and informal support from neighbors serving as critical components of their social networks. Practice and policy recommendations are provided.     

The Medical Profession and the State: GPs and the GP Contract in the 1960s and the 1990s

This paper examines the two major conflicts between general practitioners and the state in the mid-1960s and again at the end of the 1980s. In the mid-1960s morale in general practice was low, but GPs emerged with a strong endorsement from government for their professional autonomy. In 1990 morale was high, but government succeeded in imposing a new contract on GPs that sought to increase their accountability. GPs have always defended their status as independent contractors. However, the paper argues that GPs saw this status as a means of protecting their professional freedom and autonomy. When the government treated them more as independent contractors in 1990 and demanded more specific terms, GPs did not like it. Furthermore, the new GPs' contract was introduced alongside the new internal market of the NHS, which has had further implications for GPs' status as independent contractors.     

The Social Construction of Reality in the Realm of Children's Mental Health Services

ABSTRACT

Across the United States, systems of care have emerged to provide mental health care to children and their families; fragmentation inhibiting the success of collaboration by stakeholders is common and compromises these systems of care. Survey data were collected from 1,428 respondents in a Midwestern state to examine problems that exist within systems of care from the perspective of the different stakeholder groups. Stakeholder group membership was based upon the respondent's employment or involvement within various child-serving systems and included those in child welfare, juvenile justice, and education, mental health providers, and consumers (i.e., caregivers/parents). Group differences revealed patterns of “finger pointing” by the stakeholder groups on where specific problems exist within systems of care. The findings provide insight into how the social construction of service delivery and practice emerges as stakeholder groups describe, understand, and evaluate problems within the system of care as a function of their own practice location within the system of care. Future research should consider exploring methods that might minimize the competitive nature of disparate child-serving systems and its potentially negative impact upon system performance and treatment outcomes.     

布努瑶对喀斯特地区非木材林产品的利用

布努瑶作为典型的山地民族,生息地是典型的喀斯特地区。布努瑶在适应所处生态环境的过程中积累了丰富的地方性生态知识和形成了特殊的技能,对非木材林产品的保护与利用有自己独特的经验。只有发掘和利用布努瑶传统的生态智慧和技能,逐步改变布努瑶的资源利用方式,当地脆弱生态系统才可能支持布努瑶的可持续发展。     

论社会工作方法在城市社区民族工作中的运用

随着社会转型的加速进行,城市民族工作社区化已成为一种必然趋势,而社区民族工作作为一项新课题,目前尚处于探索阶段,无成熟的理论和模式;以助人自助为宗旨的专业社会工作向来有服务少数民族的经验与传统,其专业方法可以为社区民族工作的开展起到一定的借鉴作用。     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

New Destinations? Assessing the Post‐migration Social Mobility of Minority Ethnic Groups in England and Wales

This paper considers the roles of migration and group‐specific ethnic penalties in minority groups’ life chances. In relation to existing knowledge of extensive diversity between ethnic groups, and outlining a range of frameworks within which to understand that diversity, the paper first explores the relationship of class origins to parental educational and economic assets for three groups of migrant parentage and a comparison white non‐migrant group. Second, the paper investigates for the different ethnic groups how the probability of having a professional or managerial class outcome is influenced by class origins and by the educational achievements of the “second generation”. Analysis is based on the ONS Longitudinal Study, which enables the study members to be tracked from 1971, when they were children living with their parents, to their own social class outcomes in 1991 and 2001. Because processes of occupational achievement may take different lengths of time for different groups, occupational outcomes are modelled in both 1991 and 2001, and also outcomes in 2001 conditional on position in 1991. The paper shows that there is evidence of differential processes operating for different ethnic groups that go beyond their class background, but which cannot be attributed to discrimination operating equally against all minority groups.     

族群与教育不平等:我国西部少数民族教育获得的一项实证研究

摘 要：本文通过梳理国内外有关族群（民族）分层的文献,认为有必要把“民族”纳入到中国的市场转型和社会分层理论框架之中,并从教育获得的角度对这一问题进行实证分析。影响中国少数民族教育获得的因素主要包括：城乡地域区隔、职业结构（阶层）、文化差异和国家政治进程（政策变迁）。基于对2004年中国西部抽样调查数据分析,作者发现：（1）基础教育阶段入学的族群差异主要由城乡差别和阶层不平等造成,族群不平等已不显著;（2）少数民族子女高中升学概率依然显著低于汉族,其原因部分在于城乡、地域和阶层因素,部分在于少数民族和汉族的文化差异（如语言环境）等因素;（3）与汉族教育不平等的代际传递模式不同,少数民族教育不平等的代际传承以资源转化模式为主,从而影响了不同族群在教育扩展中的获益程度。总体而言,虽然中国西部少数民族的教育获得仍显著落后于汉族,但其教育不平等更多地来自城乡和阶层之间的差异。     

The Vexed Question of Market Stewardship in the Public Sector: Examining Equity and the Social Contract through the Australian National Disability Insurance Scheme

Personalized care and market‐based approaches to public service provision have gained prominence in a range of Organisation for Economic Co‐operation and Development countries. Australia has recently joined this trend, launching a complex and expansive programme of individualized care funding for disability through the National Disability Insurance Scheme. Public sector markets (i.e. where governments either directly fund a market by way of competitive tendering, or through personal budgets) have been embraced by actors at different points of the political spectrum and for a range of reasons, including efficacy and efficiency gains, empowerment of citizens and efforts to cater for diversity. Despite the growing dominance of public sector markets and individualized funding, many questions about the role and responsibility of governments in managing and regulating these markets remain unanswered. In this article we outline different roles governments might assume in the creation and management of public sector markets, based on the types of risks governments are willing to take responsibility for. We argue that to fulfil the social contract between government and citizens, governments need to ensure that markets are properly stewarded and embedded in broader social safety nets. This, we contend, can ensure citizens receive the gains of market models while being protected from market failures or market‐produced inequities.     

Organizational Form as a Mechanism to Involve Staff,Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

In addition to introducing markets and market‐like structures into public services, New Labour wished to promote the involvement of users and the public in decision‐making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state control, and transferring them to mutual ownership; or by increasing public involvement in the governance of public bodies. NHS foundation trusts (FTs) were presented as mutuals. Our study shows FTs are not mutuals, as they continue to be owned by the state. Moreover, staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations. The findings of the study are of current interest as the coalition government is continuing with the policy of FTs, and also encouraging mutuals and other forms of public involvement.     

壮族麽经布洛陀中的“麽汉皇”与布依族摩经中同类题材文献对比研究

布洛陀经诗是壮族重要的历史文献,有关"麽汉皇"的题材是经诗中重要的组成部分。贵州的布依族与壮族有着非常密切的历史渊源关系,其重要的宗教文献———摩经中也有不少与壮族布洛陀经诗内容相似的成分,摩经中的"安王"与壮族布洛陀经诗中的"汉皇"题材文献在名称、功能、内容、人物等各方面都存在着相同和不同之处。     

End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N?=?300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.     

环境关心的测量：NEP量表在中国的应用评估

本文检视了西方学者（特别是美国学者）自20世纪70年代以来测量公众环境关心的历程,分析了广为使用的NEP量表的提出及修订,并重点基于2003年中国综合社会调查（城市部分）资料,对修订过的NEP量表在中国的应用效果进行了评估。作者指出,不加改造地在中国应用修订过的NEP量表,效果并不理想。但是,经过适当改造之后,该量表可以作为测量公众环境关心的重要工具。     

The Organization of Health Policy Functions in the German Federal Government

This article gives an account of the organizational history of the German federal ministry of health (and its predecessors) since the beginnings of public policy intervention in health care. In doing so it analyses the role of ministerial organization and examines the functional and political rationale underlying acts of reorganizing the tasks and resources of federal ministries. This analysis has two sides: the first concerns the expressive function of organizational form, as revealing something about the scope and perceived importance of the policy field, while the second interrogates the policy‐shaping role of organization and the political influence of the federal health ministry in health policy‐making. The article thus considers the organizational location of health issues in the central executive from the perspective of what it reveals about government goals and priorities. Then it examines possible policy implications. It looks at resources and the size of the ministry as a first attempt to learn something about the ministry's political weight. The question of policy implications draws our attention away from organization and resource allocation and back to a focus on policy‐making and policy outcomes. The final section therefore examines substantive policy implications that might have emanated from the organizational consolidation of the federal health ministry. It concludes that one such policy implication might be the erosion of the social insurance model as a regulatory idea in health‐care services and financing.     

Learning from the Experiences of Ethnic Minorities Accessing HIV Services in Ireland

Since the mid-1990s, Ireland has become a more culturally diversesociety. To ensure equitable, culturally sensitive services,social workers need to consult with and listen to views of serviceusers. This paper reports on findings of two recent studiesby social workers in Ireland with migrants living with HIV.It highlights how many of those newly diagnosed with HIV arefrom sub-Saharan African countries and still in the asylum processand discusses barriers to accessing support and integratinginto Irish society. The paper points out that unless properlysupported, those living with HIV may find it difficult to disclosetheir HIV status and highlights the importance of tackling HIVstigma. It concludes with the need to provide training for healthcare workers to provide culturally appropriate services, andargues against immigration policies which inhibit integration.     

Disabled people in Britain and the impact of the COVID-19 pandemic

This paper reports on in-depth qualitative interviews conducted with 69 disabled people in England and Scotland, and with 28 key informants from infrastructure organisations in the voluntary and statutory sectors, about the impact of COVID-19, and measures taken to control it. Participants were recruited through voluntary organisations. As with everyone, the Pandemic has had a huge impact: we discuss the dislocations it has caused in everyday life; the failures of social care; the use of new technologies; and participants' view on leadership and communication. We conclude with suggestions for urgent short term and medium term responses, so that the United Kingdom and other countries can respond better to this and other pandemics, and build a more inclusive world.     

Developing the NICE/SCIE Guidelines for Dementia Care: The Challenges of Enhancing the Evidence Base for Social and Health Care

Internationally, interest is developing in the challenges ofdeveloping evidence-based guidelines for social work practice.The paper reports on the process of establishing the UK’sfirst joint health and social care evidence-based practice guideline,which is in dementia care. The paper addresses the methodologicaland procedural challenges of reviewing, meta-analysing and synthesizingknowledge for health and social care given the contrasting historiesof the two sectors in relation to the emergence of evidence-basedpractice. Dementia care is a complex domain within which socialand clinical perspectives intersect, reinforcing the desirabilityof producing ‘joined up’ health and social carepractice guidelines that are relevant to integrated services.It is suggested that the exemplar of producing a joint healthand social care guideline for dementia may be a model for futuredevelopment of practice guidelines. Some of the main recommendationsare presented to illustrate the character of the joint guideline,lessons are drawn for future guideline development, and implicationsfor policy and practice implementation are considered.     

Health insurance coverage of Hispanic adults: An assessment of subgroup difference and the impact of immigration

This research explores the health insurance coverage of various Hispanic subgroups in comparison to non-Hispanic whites and blacks. The impact of immigration status is also considered as we hypothesize that nativity, duration, and naturalization tap a possible process of structural acculturation that increases access to insurance coverage for Hispanic groups. We find that the immigration variables impact the type of insurance reported. However, race/ethnic disparities continue to exist, with the various Hispanic subgroups more likely to report miscellaneous government health insurance or no health insurance coverage as compared to non-Hispanic whites.     

Part-time employment and worker health in the United States

A growing body of research has highlighted the consequences of part-time employment for workers’ health and well-being. However, these studies have yielded inconsistent results and relied on cross-sectional data. In addition, relatively little empirical research has explored whether the effect of working part-time on health varies by gender, particularly in the United States. Using longitudinal data from three waves of the General Social Survey panel (2010–2012–2014), our study examined the association between part-time employment and perceived health among U.S employees, and whether this association varied by gender. The results showed that part-time workers were less likely to report poor self-rated health than full-time workers, especially among males. The pattern of results was consistent across empirical approaches—including generalized estimating equations and random effects models, with an extensive set of covariates. Taken together, these findings suggest that for U.S. employees, working part-time appears to be beneficial or at least not detrimental to perceived health, which warrants further investigation.     

Difficulty in seeking information about health care quality and costs: The field of dreams fallacy

While government agencies and health organizations have increased efforts to provide online information about health care quality and costs, we know little about whether individuals seek out or understand this information. Using results from a Louisiana telephone survey (N = 1030), we examine intent to use a website devoted to information about health care quality and costs and self-reported difficulty in finding this information. Intent to use a website is driven primarily by prior Internet use while difficulty in learning about health care quality is associated with greater choice in health care providers and dissatisfaction with current care.